Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Oct 2009
Systemic lidocaine inhibits remifentanil-induced hyperalgesia via the inhibition of cPKCgamma membrane translocation in spinal dorsal horn of rats.
Remifentanil is being used increasingly as one component of total intravenous anesthesia. Severe postoperative pain has occasionally been reported with discontinuation of remifentanil. This study was designed to determine the involvement of conventional protein kinase Cgamma (cPKCgamma) in the inhibitory action of lidocaine on remifentanil-induced hyperalgesia of rats after propofol-remifentanil-based anesthesia. ⋯ After plantar incision, the withdrawal threshold on both the contralateral and the ipsilaeral side at 30, 120, and 300 minutes postanesthesia in group R was significantly lower than in groups P, RL, and L (P<0.05). Both immunoblotting and immunofluorescence showed that cPKCgamma membrane translocation increased in dorsal horn neurons of propofol-remifentanil-based anesthetized rats, which could be inhibited by systemic lidocaine. These results suggested that increased cPKCgamma membrane translocation was involved in remifentanil-induced hyperalgesia, which was inhibited by systemic lidocaine and may contribute to reduced postoperative pain in rats after propofol-remifentanil-based anesthesia.
-
Quadriplegic patients pose difficulty for neuromuscular monitoring owing to nonavailability of accessible normal muscle. It is known that train of four responses (T4/T1 ratio) was exaggerated in paretic limbs. However, no studies have quantified the exaggeration at different degrees of block. ⋯ There was a statistically significant difference in the train of four responses between normal and paretic limbs at all levels of block except at T4/T1 81-90. There was a significant positive correlation between difference in the T4/T1 ratio between the upper and lower limbs and intensity of block in the paraplegic group but no correlation in the normal group. The observation that T4/T1 ratio enhancement in denervated limbs is dependent on depth of neuromuscular block may have future implications for monitoring and reversal of neuromuscular block in this patient population.
-
J Neurosurg Anesthesiol · Oct 2009
Randomized Controlled TrialOral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial.
Scalp infiltration with epinephrine-lidocaine solution in patients undergoing neurosurgery may result in transient but significant hypotension. We investigated whether premedication with alpha2-adrenoreceptor agonist clonidine, which also exhibits alpha1-adrenoreceptor mediated vasoconstriction, would prevent or attenuate this fall in mean arterial pressure (MAP). ⋯ In conclusion, oral clonidine 3 microg/kg administered 90 minutes before induction of anesthesia attenuates the fall in MAP due to scalp infiltration with a dilute concentration of epinephrine-lidocaine solution in patients undergoing craniotomy under isoflurane anesthesia.
-
J Neurosurg Anesthesiol · Oct 2009
Randomized Controlled Trial Comparative StudyTracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope.
The PENTAX-AWS, a novel video laryngoscope, allows indirect visualization of the vocal cords on a color monitor display and enables tracheal intubation without upward lifting force required to expose the glottis. This study compared hemodynamic changes, bispectral index scores, and postoperative sore throat before and after laryngoscopy between the Macintosh laryngoscope and the airway scope (AWS). Forty patients (American Society of Anesthesiologists I-II), randomly assigned to either the Macintosh group (n=20 each) or AWS group, were enrolled in this study. ⋯ Macintosh group). Postoperative sore throat was observed in both groups (2 out of 20 in AWS and 6 out of 20 in Macintosh), although this difference did not reach statistically significant level (P=0.23). In conclusion, the AWS offers a reduced degree of hemodynamic stimulation compared with the Macintosh laryngoscope, suggesting that tracheal intubation with the AWS is advantageous to prevent hypertension after laryngoscopy in neurosurgical patients.
-
J Neurosurg Anesthesiol · Oct 2009
A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children.
Recent animal studies have shown that commonly used anesthetic agents may have serious neurotoxic effects on the developing brain. The purpose of this study was to assess the association between surgery for hernia repair and the risk of behavioral and developmental disorders in young children. ⋯ After controlling for age, sex, and complicating birth-related conditions such as low birth weight, children who underwent hernia repair under 3 years of age were more than twice as likely as children in the comparison group to be subsequently diagnosed with a developmental or behavioral disorder (adjusted hazard ratio 2.3, 95% confidence interval 1.3, 4.1). Our findings add to recent evidence of the potential association of surgery and its concurrent exposure to anesthetic agents with neurotoxicity and underscore the need for more rigorous clinical research on the long-term effects of surgery and anesthesia in children.